Knirsch C A, Jain N L, Pablos-Mendez A, Friedman C, Hripcsak G
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, USA.
Infect Control Hosp Epidemiol. 1998 Feb;19(2):94-100. doi: 10.1086/647773.
To evaluate a clinical guideline and an automated computer protocol for detection and respiratory isolation of tuberculosis (TB) patients.
An automated computer protocol was tested on a retrospective cohort of adult culture-positive TB patients admitted from 1992 to 1993 to Columbia-Presbyterian Medical Center and evaluated prospectively from July 1995 until July 1996.
A large teaching hospital in New York City.
171 adult patients admitted from 1992 to 1993 and 43 patients admitted between July 1995 and July 1996.
The 1990 Centers for Disease Control and Prevention guidelines for preventing transmission of TB were adapted to formulate clinical guidelines to ensure early isolation of TB patients at Columbia-Presbyterian Medical Center.
Implementation of a clinical respiratory isolation protocol resulted in a significant improvement in TB patient isolation rates, from 45 (51%) of 88 in 1992 to 62 (75%) of 83 in 1993 (P<.001). In testing automated protocols, the theoretical improvement would have identified an additional 27 patients not isolated by clinicians, making the overall isolation rate 134 (78%) of 171. For the prospective evaluation, 30 (70%) of 43 TB patients were isolated by clinicians adhering to the clinical protocol. Four additional patients were identified by the automated TB protocol, making the combined isolation rate 34 (79%) of 43.
A clinical policy to isolate TB patients and suspected human immunodeficiency virus-infected patients with cough, fever, or radiographic abnormalities improved isolation of culture-documented TB patients from 1992 to 1993. Automated computer protocols were successful in identifying additional potentially infectious patients that clinicians failed to place on respiratory isolation. Clinical and automated protocols combined resulted in better isolation rates than a clinical protocol alone.
评估一项用于检测和呼吸道隔离结核病（TB）患者的临床指南及自动化计算机协议。
一项自动化计算机协议在1992年至1993年收治于哥伦比亚长老会医学中心的成年培养阳性TB患者的回顾性队列中进行测试，并于1995年7月至1996年7月进行前瞻性评估。
纽约市的一家大型教学医院。
1992年至1993年收治的171例成年患者以及1995年7月至1996年7月收治的43例患者。
采用1990年美国疾病控制与预防中心预防TB传播的指南来制定临床指南，以确保在哥伦比亚长老会医学中心尽早隔离TB患者。
实施临床呼吸道隔离协议后，TB患者隔离率显著提高，从1992年88例中的45例（51%）提高到1993年83例中的62例（75%）（P<0.001）。在测试自动化协议时，理论上的改进本可识别出另外27例未被临床医生隔离的患者，使总体隔离率达到171例中的134例（78%）。对于前瞻性评估，43例TB患者中有30例（70%）被遵循临床协议的临床医生隔离。自动化TB协议又识别出另外4例患者，使综合隔离率达到43例中的34例（79%）。
1992年至1993年期间，隔离TB患者以及咳嗽、发热或有影像学异常的疑似人类免疫缺陷病毒感染患者的临床政策改善了培养确诊TB患者的隔离情况。自动化计算机协议成功识别出了临床医生未能进行呼吸道隔离的其他潜在感染患者。临床协议与自动化协议相结合的隔离率高于单独的临床协议。
